Heparin-induced thrombocytopenia in the presence of a heparin-bonded bypass graft

The use of prosthetic grafts in below-knee bypasses may be necessary in patients with no available autologous vein and critical limb ischemia not amenable to angioplasty. Such conduits, however, have generally yielded disappointing results. A new, heparin-bonded, expanded polytetrafluoroethylene graft (Gore Propaten vascular graft) designed to provide resistance to thrombosis may be associated with decreased early graft failure and increased patency. A concern with exposure to heparin, and therefore heparin-bonded prostheses, is the development of heparin-induced thrombocytopenia (HIT). Although rare, this requires prompt graft removal. We present a case to highlight this serious complication and review the literature on this topic.